Health literacy and adolescents' substance use behaviors and correlates: a scoping review.

From 2011 to 2023, substance use increased by 23% worldwide. Given that substance use initiation is highest during adolescence, it is crucial to identify amenable correlates of substance use prevention [e.g. health literacy (HL)], which, if embedded in interventions, may improve uptake and outcomes. Hence, this study conducted a scoping review to answer the question: What is known from the existing literature about the relationship between HL and substance use correlates and behaviors in adolescents? Five electronic databases and the bibliography of review articles were searched and a total of 1770 records were identified. After removing duplicates and engaging in three levels of screening to identify studies that included adolescents ≤ 25 years old and assessed the relationship between general HL (vs. behavior/disease-specific health knowledge) and substance use behaviors and correlates, 16 studies were retained. Studies assessed alcohol-related (n = 11), tobacco-related (n = 12), electronic vapor product use-related (n = 4), cannabis-related (n = 1), and amphetamines/methamphetamines-related (n = 1) outcomes. Studies spanned Africa, Asia, Europe, and North and Central America. Most studies included substance use as an outcome and found an inverse relationship between HL and use. Few studies examined substance use correlates (e.g. risk perception). There were no longitudinal or intervention studies. This review highlighted that the topic of adolescent HL and its relationship with substance use remains inadequately researched. Notable gaps for future studies include intervention and longitudinal designs, expansion of outcomes (e.g. more studies on marijuana, prescription drug misuse, vaping, substance use-related correlates), and examining HL as a mediator or moderator of substance use and its correlates.

Racial and ethnic minority status in country of birth modifies racial and ethnic disparities in influenza vaccination among New York City adults.

BACKGROUND: Understanding the relationship between race/ethnicity, birthplace, and health outcomes is important for reducing health disparities. This study assessed the relationship between racial/ethnic identity and minority racial/ethnic status in country of birth on influenza vaccination among New York City (NYC) adults. METHODS: Using 2015-2019 data from NYC's Community Health Surveys, we assessed the association between racial/ethnic identity and racial/ethnic minority status in birth country with past year influenza vaccination, calculating prevalence differences per 100 and assessing interaction on the additive scale using linear binomial regression, and prevalence ratios and interaction on the multiplicative scale using log-binomial regression. RESULTS: Effect modification between race/ethnicity and minority racial/ethnic status in birth country was significant on the additive scale for Hispanic (p = 0.018) and Black (p = 0.025) adults and the multiplicative scale for Hispanic adults (p = 0.040). After stratifying by racial/ethnic minority or majority status in birth country, vaccination was significantly lower among Black adults compared with White adults among those in the minority (adjusted prevalence difference [aPD]=-12.98, 95%CI: -22.88-(-2.92)) and significantly higher among Hispanic adults compared with White adults among those in the majority (aPD=9.28, 95%CI: 7.35-11.21). CONCLUSIONS: Racial/ethnic minority status in birth country is an important factor when examining racial/ethnic differences in vaccination status.

Linking Childhood Cultural Health Capital Factors with Adult Health Literacy.

Adult health outcomes are linked to childhood factors such as socioeconomic status via cultural health capital (CHC). Specifically, these factors shape opportunities for developing skills for navigating health environments via experience and the intergenerational transfer of health-related knowledge and skills. Health literacy (HL) is considered a part of and/or result of CHC. HL develops similarly to CHC via opportunities and experiences. Most research to date has ignored the effect of childhood factors on adult HL. The purpose of this study was to explore how childhood factors are related to adult HL. Data were collected from adults (N = 736, mean age = 40.65 years, standard deviation [SD] = 15.39; 52% female; 53.8% White, 31.3% Hispanic and Latino/a/e) in the United States using Qualtrics Panel. Multivariate ordinal and binary logistic regressions predicting HL (as measured by the Newest Vital Sign and Single-Item Literacy Scale) from childhood factors and accounting for demographic covariates were estimated. After accounting for covariates, such as the presence of an employed adult in a white-collar (odds ratio [OR] = 3.34) or blue-collar (OR = 3.68) occupation (versus unknown/not employed) increased the odds of being categorized as possible limited literacy and adequate literacy (versus limited literacy) as measured by the Newest Vital Sign. Similarly, having an employed adult during childhood who had a blue-collar occupation (vs. unknown/not employed) increased the odds of being categorized as adequate literacy (OR = 2.06) as measured by the Single-Item Literacy Scale. Because the adult's employment played a role in the child's adult HL after accounting for other factors and demographics, these findings support using a lifespan approach to assess and identify risk factors for lower HL. This study contributes to the growing body of evidence of how HL is interconnected with social determinants of health across the lifespan and the need to address HL skills in those with poor social determinants of health. [HLRP: Health Literacy Research and Practice. 2024;8(2):e79-e88.].

PLAIN LANGUAGE SUMMARY: Childhood conditions, such as family financial position, may be related to adult health literacy. Adults who had limited income as children were more likely to have lower health literacy than those whose family members had white-collar and blue-collar jobs. Therefore, it is important that childhood factors be considered when identifying groups that may benefit from health literacy interventions.

Effects of parental childhood cultural health environment on children's influenza and COVID-19 vaccination status.

Most studies examining factors associated with pediatric influenza (flu) and coronavirus disease (COVID-19) vaccination uptake focus on parental demographics. We examined whether the childhood cultural health environment (CHE) of parents (measured by self-reported regular attendance at doctor and dentist visits during childhood) was associated with flu and COVID-19 vaccination of their children. Using 2023 survey data from 397 US parents and causal inference methods, we estimated the average causal effect of parental CHE on flu vaccination rates (0.16 [95 % confidence interval: 0.06,0.27]) and COVID-19 (0.14 [95 % confidence interval: 0.04,0.24]), indicating that if all parents had attended regular doctor/dentist visits as children, flu and COVID-19 vaccination rates in children would be 16 % and 14 % higher, respectively, than if none had. Our findings suggest that early life exposure to medical and dental care has significant and lasting effects on the health of individuals and families.

The Relationship Between a Healthy People 2030 Health Literacy-Related Objective (HC/HIT02) and Cancer Prevention and Screening Behaviors.

Healthy People 2030 highlights the importance of both personal and organizational health literacy (HL) to improving population health. Yet, most research focuses on personal-level HL or fails to study the effect of both types of HL on health behavior. This study explored the relationships between organizational HL (Healthy People 2030 objective: decrease the proportion of adults who report poor communication with their health care provider), personal-level HL, and cancer prevention and screening behaviors. Data were collected using Qualtrics Panel. Participants who indicated they had a non-emergency room provider visit in the last 12 months were included in the analyses. Participants (n=549, Mean age = 41.44 years, SD = 15.91; 51.9% female; 54.3% White, 28.8% Hispanic/Latino/a/x) completed measures of personal and organizational HL and reported on their cancer prevention (e.g., cigarette smoking) and screening (e.g., mammogram) behaviors. Hierarchical linear and logistic regressions predicting cancer prevention and screening behaviors, respectively, from organizational HL, personal HL, and demographic covariates, were estimated. Regarding the results, higher organizational HL was related to higher fruit and vegetables consumption and physical activity after accounting for personal-level HL and demographic covariates. Higher personal-level HL was related to lower physical activity, binge-drinking, and cigarette smoking, and higher odds of pap smear screening, prostate-specific antigen testing, and completing all eligible screenings after accounting for organizational-level HL and demographic covariates. The findings support that personal-level and organizational HL may be differentially important to improving cancer prevention and screening behaviors. Policies that address improving both personal-level and organizational-level HL are needed.

Examining provider anticipatory guidance for adolescents' preventive health: A latent class approach.

BACKGROUND: Low rates of anticipatory guidance (AG) are reported across studies with adolescents, and little is known about how these conversations differ across early versus middle adolescence. This study explored adolescent-provider AG conversations for preventive health skills; the study objectives were to (1) identify patterns of provider-adolescent AG conversations across early and middle adolescence and (2) determine socio-demographic characteristics associated with these AG conversations. DESIGN AND METHOD: Data from the 2019 National Survey of Children's Health were used to identify patterns of provider-adolescent AG conversations. The sample included 5500 early and 6730 middle adolescents (Mage = 14.67 years old, SD = 1.71, 51.7% boys, 79% White). Multiple group latent class analysis and multinomial regressions were estimated using four indicators of AG conversations (i.e., skills to manage health and healthcare, changes in healthcare that happen at 18, making positive choices about health, and receiving a medical history summary). RESULTS: Three types of AG conversations were identified: high AG, low AG, and parent unaware. Among early and middle adolescents, adolescents that were older, girls, had private health insurance, and a personal provider were less likely to receive high AG compared to other types of AG. CONCLUSIONS: Policies and strategies to engage adolescents in AG conversations during and outside of the medical appointment are needed. PRACTICE IMPLICATIONS: Tools, such as brief screeners, can be used to ensure all adolescents are receiving high AG. School-based health centers, community centers and organizations, and telehealth appointments with medical professionals may be additional opportunities for adolescents to receive AG.

Safety, Efficacy, and Ill Intent: Examining COVID-19 Vaccine Perceptions among the New Undervaccinated Moveable Middle in a U.S. Cohort, October 2022.

Individuals who received their primary vaccine series only (with no subsequent booster) may be a new type of "moveable middle" given their receipt of the original COVID-19 vaccination. One population within the moveable middle for whom tailored interventions may be needed is individuals with common mental disorders (CMD). The purpose of this paper is to understand the vaccine perceptions among this new moveable middle-the undervaccinated-and within the undervaccinated to examine the extent to which COVID-19 vaccine perceptions and motivations differ among those with and without symptoms of CMD. Using data from the CHASING COVID Cohort, we examine the relationship between vaccination status, CMD, and vaccine perceptions in the undervaccinated. Among 510 undervaccinated participants who had completed the primary vaccine series but were not boosted, the most common reasons for undervaccination focused on efficacy (not seeing a need for an additional dose, 42.4%; there not being enough evidence that a booster dose is effective, 26.5%; already having had COVID-19, 19.6%). Other concerns were related to safety (long-term side effects, 21.0%; short-term side effects, 17.6%) and logistics (plan to get a booster but haven't had time yet, 18.8%). Overall, the greatest vaccine concerns (over 30%) for the undervaccinated focused on efficacy and safety issues. Symptoms of depression or anxiety were associated with lower levels of vaccine efficacy and greater safety concerns in adjusted models. The implications of our study are that campaigns that are hoping to maximize vaccination uptake should consider focusing on and emphasizing messaging on efficacy and safety issues.

Validation of the Assessments of Adult Health Literacy: A Rasch Measurement Model Approach.

Background: Both the World Health Organization and U.S. Department for Health and Human Services have emphasized the importance of health literacy (HL) to improving population health and reducing health disparities. HL includes three core areas/qualities: functional (i.e., health-related reading, writing, and numeracy), interactive/communicative (i.e., skills for interacting with multiple constituents and sources of information and navigating the health environment), and critical (i.e., personal and community advocacy for health). HL is implicated in medical adherence, preventive health, mental health stigma and help-seeking, and health decision-making. Though HL is critical to health and health decision-making, research on HL is still relatively limited, with most research focusing on functional HL. A major gap in research is related to the lack of measurement of interactive and critical HL. To address this gap, this study modified and assessed the validity of the Assessments of Adolescent Health Literacy (AAHL-Adolescent), test-based assessments of adolescents' functional, interactive, and critical HL, in an adult sample. Methods: One item from the AAHL-Adolescent item bank was modified to be more appropriate for an adult sample. Adults (n=2346) completed a measurement battery that included the HL item bank (12 functional, 15 interactive, and 9 critical HL questions), Newest Vital Sign (NVS), Single-Item Literacy Scale (SILS), demographics, and questions about HL-related behaviors. The assessments were evaluated and validated using Rasch measurement models. Convergent and criterion validity were assessed. Results: The final 7-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (24 items) fit their respective Rasch models. Item-level invariance was established for gender, ethnicity, education, and age across all assessments. Differential item functioning for race was noted for two items on the interactive HL assessments. Good convergent validity with the NVS and SILS and good criterion validity with the HL-related behaviors were observed for all assessments. Conclusions: The AAHL-Adult is the first test-based instrument validated in the U.S. that includes assessments for all three core qualities of HL. These assessments have utility across multiple settings, including public health program planning and evaluation, intervention development and evaluation, and clinical settings.

Correction: Fleary et al. Census Tract Demographics Associated with Libraries' Social, Economic, and Health-Related Programming. Int. J. Environ. Res. Public Health 2022, 19, 6598.

The authors wish to make the following corrections to this paper [...].

Psychosocial correlates in patterns of adolescent emotional eating and dietary consumption.

Unhealthy eating behaviors, such as consumption of unhealthy diet and emotional eating, are common in adolescence and tend to co-occur. However, how these behaviors are patterned may vary among adolescents. This study identified patterns of dietary consumption and emotional eating behaviors in adolescents and examined the sociodemographic and psychosocial (e.g., self-efficacy beliefs and motivation) covariates associated with these eating patterns. Data were from the Family Life, Activity, Sun, Health and Eating study. Latent class analysis was used to estimate adolescent dietary patterns from dietary consumption (i.e., fruits, vegetables, sugar-sweetened beverages, junk food, etc.) and emotional eating variables (i.e., eating when feeling sad or anxious). The sample included 1,568 adolescents (Mean age = 14.48-years-old, 49% girls, 55% White). A four-class solution best fit the data (e.g., Bayesian Information Criteria [BIC] = 12263.568, three-class model BIC = 12271.622). Four unhealthy eating behavior patterns were identified: poor diet/high emotional eating, mixed diet/high emotional eating, poor diet/low emotional eating, and mixed diet/low emotional eating. Compared to the poor diet/high emotional eating group, the other groups were less likely to include older adolescents, girls, and adolescents who experienced food insecurity, and more likely to have higher self-efficacy for eating fruits and vegetables and limiting junk foods as well as motivation for consuming fruits and vegetables and limiting junk foods. Our findings highlight adolescents' complex dietary patterns that include dietary consumption and emotional eating behaviors. Future studies should examine other potential dietary patterns that include emotional eating. Efforts to address unhealthy patterns of adolescents' dietary consumption and emotional eating behaviors should be expanded.

The relationship between health literacy and correlates of adolescents' obesogenic and substance use behaviors.

PURPOSE: Risk perception (RP) and self-efficacy are targeted in adolescent health behavior interventions, however these variables have not been explored in relation to health literacy (HL). HL may affect how adolescents assess, prioritize, and integrate information when forming RP and self-efficacy and, ultimately, their health behaviors. This study assessed the relationship between functional, interactive, and critical HL and adolescents' behavior-specific RP and self-efficacy and health behaviors. DESIGN AND METHODS: Cross-sectional data were collected from 380 adolescents attending high school via an online survey. Survey measures included demographics, functional, interactive, and critical HL, and substance use and obesogenic behavior-related beliefs, attitudes, and behaviors. Pearson correlations and regressions were estimated. RESULTS: The relationship between HL and RP, self-efficacy, and behaviors varied by behavior and HL type. Critical HL was related to obesogenic-specific RP and behaviors, while interactive and critical HL were related to self-efficacy. Interactive and critical HL were related to substance use-specific RP and self-efficacy while functional and interactive HL were related to substance use behaviors. HL moderated several RP/behavior and self-efficacy/behavior relationships. CONCLUSIONS: The significant relationships between HL and RP and self-efficacy highlight how HL may be an underlying factor or help shape adolescents' perceptions and beliefs adolescents have about behaviors and themselves, which ultimately influence their behaviors. PRACTICAL IMPLICATIONS: Adolescent interventions should be assessed to determine what underlying HL skills are needed for behavior change and assess and address HL directly as adolescents with low HL may be at a disadvantage for intervention uptake and outcomes.

Housing and Food Insecurity, Health Literacy, and Maladaptive Coping Behaviors.

BACKGROUND: Stressors related to social determinants of health (SDH), such as housing and food insecurity, are implicated in chronic disease risk. Maladaptive strategies for coping with these stressors may exacerbate risk. OBJECTIVE: Given the limited research on SDH-related stressors and maladaptive coping, this study examined the relationship between two SDH-related stressors (housing and food insecurity) and maladaptive coping behaviors (i.e., emotional eating and stress-related cigarette and alcohol use) in adults. Further, because health literacy (HL), another SDH, may be a protective factor, this study explored whether HL moderated these relationships. METHODS: Data were collected from adults (N = 500, Mean age = 49.01 years, standard deviation = 16.36; 40% White) in the United States. A series of hierarchical logistic regressions predicting maladaptive coping behaviors from demographics, SDH-related stressors (i.e., housing or food insecurity), and HL variables were estimated. KEY RESULTS: Housing insecurity was associated with increased odds of emotional eating (odds ratio [OR] = 1.48, p < .001), stress-related cigarette use (OR = 1.34, p = .001), and stress-related alcohol use (OR = 1.32, p = .001). Food insecurity was associated with increased odds of emotional eating (OR = 1.49, p = .012), stress-related cigarette (OR = 1.68, p = .002), and stress-related alcohol use (OR = 1.49, p = .013). Higher functional HL scores were associated with decreased odds of emotional eating after accounting for housing (OR = 0.79, p = .017) and food insecurity (OR = 0.76, p = .004). Communicative and critical HL moderated the relationship between food insecurity and emotional eating. CONCLUSIONS: Examining HL in relation to SDH-related stressors and maladaptive coping behaviors is complex. HL may be less protective for maladaptive coping behaviors that are likely addictive. Because HL domains may require cooperation between individuals and systems related to stressors, multi-systemic interventions are necessary to reduce maladaptive coping behaviors. [HLRP: Health Literacy Research and Practice. 2022;6(4):e280-e289.] Plain language summary: Stress related to inadequate resources for housing and food may be related to adults' poor coping behaviors (e.g., emotional eating and stress-related cigarette and alcohol use). Adults who experienced housing and food insecurity were more likely to report emotional eating and using cigarettes and alcohol when stressed. Adults with higher functional health literacy were less likely to report emotional eating.

The Relationship Between Health Literacy and Mental Health Attitudes and Beliefs.

BACKGROUND: Mental health first aid programs show promise in reducing stigma and increasing help-seeking. However, the success of these and other mental health interventions are likely affected by health literacy. Yet, health literacy is understudied in the mental health literature and rarely considered in mental health interventions. OBJECTIVE: This study explored the relationship between health literacy and mental health stigma, aversion to mental health help-seeking, and willingness to interact with individuals with mental illnesses. METHODS: Adults (N = 601, mean age = 45.64) completed online surveys of their health literacy and mental health attitudes and beliefs. Hierarchal linear regression models were estimated to examine the relationship between health literacy and mental health attitudes and beliefs. Path models were estimated to determine if stigma mediated the relationship between health literacy and (1) aversion to help-seeking and (2) willingness to interact with individuals with mental illnesses. KEY RESULTS: Adults with higher functional and communicative health literacy had lower mental health stigma and aversion to mental health help-seeking. Adults with higher communicative health literacy and empowerment were more willing to interact with individuals with mental illnesses. Mental health stigma partially mediated the relationships between communicative health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses. Mental health stigma fully mediated the relationships between functional health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses. CONCLUSIONS: Results support including health literacy in mental health interventions and reiterate addressing stigma in community and clinical settings. [HLRP: Health Literacy Research and Practice. 2022;6(4):e270-e279.] Plain Language Summary: Many adults with mental health problems do not get help because of negative beliefs about mental health. We found that adults with more skills for accessing, understanding, and using health information had fewer negative opinions and were more willing to interact with others with mental health problems. Improving those skills may reduce negative opinions about mental health and seeking help.

"What gets people in the door": An integrative model of student veteran mental health service use and opportunities for communication.

Objective: To explore barriers and facilitators to mental health care among the student service member and veteran (SSM/V) population, develop an integrative model of mental health service use, and identify health communication opportunities. Participants: Participants were 21 current and former SSM/Vs recruited online and via snowball sampling. Methods: We conducted an emergent thematic analysis of in-depth interviews that took place in February 2021. Results: We identified eight major themes. Two were contextual (military culture, SSM/V identities), three were navigational (career repercussions, recognizing need, service availability/quality), and three were paths forward (high-quality accessible services, veteran peers/spaces, relevant outreach). Conclusions: We recommend higher education institutions promote SSM/V spaces, position mental health care as utilitarian, improve everyday mental health literacy, highlight service accessibility and quality, and deliver communications that reflect the diversity of SSM/V identities beyond the "warrior" archetype.

Health literacy and health behaviors in parent-adolescent dyads: an actor-partner interdependence model approach.

OBJECTIVE: Health literacy (HL), skills for accessing, appraising and using health information in health decision-making is implicated in adolescents' health behaviors. HL skills develop through scaffolding, modeling, practice and opportunity. Therefore, adolescents' HL skills are likely closely tied to parents' HL and health behaviors. Yet, no studies have examined the dyadic interdependence of the relationship between HL and health behaviors between parents and adolescents. The purpose of this study was to determine the interdependence of adolescents' and parents' HL and health behaviors. METHODS AND MEASURES: Data were collected from 300 parent-adolescent dyads via Qualtrics Panel. Dyads completed identical measures of their HL, diet, physical activity, sedentary activity, cigarette-smoking, vaping, and alcohol binge-drinking behaviors. Data were analyzed using Pearson correlations and the Actor-Partner Interdependence Model. RESULTS: Within-dyad correlations were significant for HL and all health behaviors assessed. After controlling for covariates and partner effects, adolescents' HL was related to their sugar-sweetened beverage intake, sedentary activity, and substance use. After controlling for covariates and actor effects, adolescents' HL was related to parents' sedentary activity, binge-drinking, and vaping while parents' HL was related to adolescents' sedentary activity. CONCLUSION: Our results suggest that there is interdependence in these relationships especially for risk behaviors.

A Web-Based Intervention to Improve Health Literacy and Obesogenic Behaviors Among Adolescents: Protocol of a Randomized Pilot Feasibility Study for a Parallel Randomized Controlled Trial.

BACKGROUND: Predictive theoretical models suggest that health knowledge works in conjunction with motivation and behavioral skills to influence adolescents' obesogenic behavior. However, most of the existing adolescent interventions target these variables in isolation. Furthermore, health literacy (HL), a precursor to health knowledge, is necessary for translating health knowledge into behavior and is negatively related to adolescents' obesity status. However, HL has not been included in obesity interventions targeting adolescents. OBJECTIVE: This study aims to pilot the feasibility of a 2-armed web-based obesity prevention intervention in school settings and assess the preliminary effectiveness of adding an HL module to an obesity prevention intervention for adolescents. METHODS: This web-based pilot feasibility study will take place in the Northeastern United States. Participants will be adolescents (aged 13-16 years) attending school, and recruitment will be conducted through flyers to parents and adolescents in participating classes or advisory groups at the school. The intervention includes 2 arms: an experimental arm that will receive an HL module and 3 obesity prevention modules and a comparison arm that will receive a vaping module and 3 obesity prevention modules. A blinded randomized procedure will be used to allocate classrooms and advisory groups to the experimental and comparison arms. The intervention will be fully web-based. Participants will complete measures of their HL and obesogenic behavior-related health knowledge, motivation, and behaviors at 3 time points (baseline, 1 month after the intervention, and 3 months after the intervention) via web-based surveys. The primary outcomes will be the measures of study feasibility (recruitment, retention, completion, and treatment fidelity rates). Secondary outcomes will be preliminary efficacy, as measured by logistic and linear regressions and calculation of effect sizes. Descriptive statistics will be calculated for all measures at each time point. RESULTS: This study was approved by the City University of New York Institutional Review Board in August 2020. As of June 2022, the web-based intervention design is complete and ready for use. Recruitment, data collection, and intervention implementation are scheduled to begin in September 2022. These results are expected to be published in 2023. CONCLUSIONS: This study's feasibility findings will inform changes to the intervention content and randomized controlled trial design. The study's efficacy findings will inform the sample size for the full-scale randomized controlled trial and the preliminary utility of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04252677; https://clinicaltrials.gov/ct2/show/NCT04252677. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40191.

Census Tract Demographics Associated with Libraries' Social, Economic, and Health-Related Programming.

Background: Public libraries can contribute to reducing economic, social, and health inequities through their programming and practices. However, the extent to which libraries regularly provide programming that improve the social determinants of health (SDH) in underserved communities is unclear. Objective: This study explored the relationship between census tract demographic characteristics and library programming implicated in the SDH for underserved groups at risk for health disparities. Method: A stratified random sample of libraries (n = 235) who completed the 2017 Public Libraries Survey were recruited. Librarians completed surveys about their libraries' economic, social, and health-related programming. Libraries' census tract demographic characteristics were taken from the 2013-2017 American Community Survey. Linear regressions were estimated to determine the relationship between relevant census tract demographic characteristics and programming offered at libraries in the census tracts. Results: Higher proportions of racial and ethnic minorities were associated with more frequent economic and social programs, but results were mixed for health-related programs. Lower proportions of populations with no more than a high school diploma or GED were related to more frequent economic, social, and health-related programs. Conclusions: The inequitable distribution of SDH-related library programming highlights gaps in libraries' responsiveness to community needs. Libraries' programming likely perpetuate systemic inequities.

Development and Validation of the Adolescent Media Health Literacy Scales: Rasch Measurement Model Approach.

BACKGROUND: High media use has been implicated in negative social and health outcomes among adolescents. Therefore, it is critical that adolescents develop skills to healthily engage with media content. Media health literacy (MHL), skills for assessing and responding to health-related media content, and potentially targetable moderators for the relationship between media use and health-related outcomes are understudied in adolescents. The lack of MHL assessment tools may have contributed to this research gap. OBJECTIVE: This study aimed to develop and validate test-based scales of adolescents' MHL. METHODS: The items developed were vetted iteratively via community reviews and cognitive interviews to establish content and face validity. Adolescents (N=355) completed a questionnaire that included the revised MHL items. The scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) were validated using Rasch measurement models. Convergent validity was assessed by correlating the summed scores of the three scales with existing functional and internet-related health literacy measures. Criterion validity was assessed by modeling logistic regressions for predicting health literacy-related behaviors from each scale after controlling for demographics. Effect sizes were estimated, and a short form was also validated. RESULTS: The final MHL scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) fit their Rasch models. The 9-item Recognition/Identification and 9-item Influence/Critical Analysis scales had good convergent validity with functional and internet-related health literacy measures and were positively related to reading instructions before taking medicines and questioning the truthfulness of health information found online. The 12-item MHL Scales-Short Form also had good convergent and criterion validity. However, convergent and criterion validity were not established for the 3-item Action/Reaction Scale. CONCLUSIONS: The Recognition/Identification and Influence/Critical Analysis scales and the MHL Scales-Short Form may be used to determine the impact of MHL on media use and health outcome relationships and ultimately inform the development of interventions and policies to affect these relationships in multiple settings.

Missed routine pediatric care and vaccinations in US children during the first year of the COVID-19 pandemic.

The COVID-19 pandemic has decreased uptake of pediatric preventive care, including immunizations. We estimate the prevalence of missed pediatric routine medical visits and vaccinations over the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey of 2074 US parents of children ≤12 years in March 2021 to measure the proportion of children who missed pediatric care and vaccinations over the first 12 months of the COVID-19 pandemic. Poisson regression models were fitted to estimate adjusted prevalence ratios (aPR). All analyses were weighted to represent the target population. Overall, 41.3% (95%CI 38.3-43.8) of parents reported their youngest child missed a routine medical visit due to the COVID-19 pandemic. Missed care was more common among children ≥2 years compared to <2 years (aPR 1.82; 95%CI 1.47-2.26) and Hispanics compared to non-Hispanic Whites (aPR 1.31; 95%CI 1.14-1.51). A third of parents (33.1%; 95%CI 30.7-35.5) reported their child had missed a vaccination. Compared to the 2019-20 flu season, pediatric influenza vaccination decreased in 2020-21 (51.3% vs. 62.2%; p < 0.0001). A high proportion of US children ≤12 years missed routine pediatric care during the COVID-19 pandemic. Catch-up efforts are needed to ensure continuity of preventive care for all children.